From the Department of Neurology (A.W., S.L., N.Z., L.D., Y.Z., Y.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China.
China National Clinical Research Center for Neurological Diseases (A.W., S.L., N.Z., L.D., Y.Z., Y.W., X.M., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China.
Stroke. 2018 Nov;49(11):2637-2642. doi: 10.1161/STROKEAHA.118.022077.
Background and Purpose- Oxidized low-density lipoprotein (oxLDL) level is thought to be associated with recurrent stroke. We aimed to investigate the association between oxLDL to high-density lipoprotein (HDL) ratio and recurrent stroke in patients with minor stroke or transient ischemic attack. Methods- The study included 3019 patients with minor ischemic stroke or high-risk transient ischemic attack from the CHANCE trial (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events). Baseline oxLDL and HDL levels were measured. The primary outcome was any stroke within 90 days. The secondary outcomes included any stroke within 1 year and ischemic stroke and combined vascular events within 90 days and 1 year. The association between oxLDL/HDL and recurrent stroke was analyzed by using Cox proportional hazards. Results- Patients in the highest oxLDL/HDL quartile had a higher risk of recurrent stroke within 90 days (hazards ratio, 1.50; 95% CI, 1.08-2.08) compared with the lowest quartile after adjusting relevant confounding factors ( P=0.02). Similar results were found for secondary outcomes ( P<0.05 for all). There were no significant interaction between oxLDL/HDL and use of statins agents. Conclusions- Higher serum oxLDL/HDL level in minor stroke or transient ischemic attack was associated with increased risk of recurrent stroke in 90 days and 1 year. OxLDL/HDL may act as a powerful indicator of recurrent stroke in patients with minor stroke or transient ischemic attack. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT00979589.
背景与目的-氧化型低密度脂蛋白（oxLDL）水平被认为与复发性卒中相关。我们旨在研究在小卒中或高危短暂性脑缺血发作患者中，oxLDL 与高密度脂蛋白（HDL）比值与复发性卒中的相关性。方法-该研究纳入了 CHANCE 试验（氯吡格雷在伴有急性非致残性脑血管事件的高危患者中的应用）中的 3019 例小缺血性卒中和高危短暂性脑缺血发作患者。检测了基线 oxLDL 和 HDL 水平。主要终点为 90 天内的任何卒中。次要终点包括 1 年内的任何卒中和 90 天和 1 年内的缺血性卒中和联合血管事件。采用 Cox 比例风险分析 oxLDL/HDL 与复发性卒中的相关性。结果-与最低 quartile 相比，oxLDL/HDL 四分位最高 quartile 的患者在 90 天内发生复发性卒中的风险更高（危险比，1.50；95%CI，1.08-2.08），校正了相关混杂因素后（P=0.02）。次要终点也得到了类似的结果（P<0.05）。oxLDL/HDL 与他汀类药物的使用之间没有显著的交互作用。结论-小卒中或短暂性脑缺血发作患者的血清 oxLDL/HDL 水平较高，与 90 天和 1 年内的复发性卒中风险增加相关。oxLDL/HDL 可能是小卒中或短暂性脑缺血发作患者复发性卒中的有力指标。临床试验注册-网址：http://www.clinicaltrials.gov 。独特标识符：NCT00979589。
